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Treating heart disease risk

A recent cholesterol study raises questions about how far doctors should go in treating people who are at low risk of future heart disease.

The dilemma is this: most people who have a heart attack or stroke are actually at low risk. Why? Well it's just numbers - there are more low risk people in the population than high risk. So while the rate of events might lower, the overall numbers are higher. And in any case we have to die of something and around half of all people aged 50 will one day die of heart disease.

The study looked at people at low risk of heart disease yet on ultrasound of their carotid arteries had thickening of the lining suggesting early atherosclerosis. They were put on a cholesterol lowering medication and those on the statin had slower progression over two years than the placebo group.

In the US doctors are aggressively estimating people's heart risk, doing these ultrasounds and treating on that basis. But the cost is enormous and slowing the thickening doesn't mean fewer heart attacks or strokes, or that the treatment will be safe for the decades it'll have to continue.